X-Ray Phase-Contrast CT of a Pancreatic Ductal Adenocarcinoma Mouse Model

To explore the potential of grating-based x-ray phase-contrast computed tomography (CT) for preclinical research, a genetically engineered mouse model of pancreatic ductal adenocarcinoma (PDAC) was investigated. One ex-vivo mouse specimen was scanned with different grating-based phase-contrast CT imaging setups covering two different settings: i) high-resolution synchrotron radiation (SR) imaging and ii) dose-reduced imaging using either synchrotron radiation or a conventional x-ray tube source. These experimental settings were chosen to assess the potential of phase-contrast imaging for two different types of application: i) high-performance imaging for virtual microscopy applications and ii) biomedical imaging with increased soft-tissue contrast for in-vivo applications. For validation and as a reference, histological slicing and magnetic resonance imaging (MRI) were performed on the same mouse specimen. For each x-ray imaging setup, attenuation and phase-contrast images were compared visually with regard to contrast in general, and specifically concerning the recognizability of lesions and cancerous tissue. To quantitatively assess contrast, the contrast-to-noise ratios (CNR) of selected regions of interest (ROI) in the attenuation images and the phase images were analyzed and compared. It was found that both for virtual microscopy and for in-vivo applications, there is great potential for phase-contrast imaging: in the SR-based benchmarking data, fine details about tissue composition are accessible in the phase images and the visibility of solid tumor tissue under dose-reduced conditions is markedly superior in the phase images. The present study hence demonstrates improved diagnostic value with phase-contrast CT in a mouse model of a complex endogenous cancer, promoting the use and further development of grating-based phase-contrast CT for biomedical imaging applications.     

Le ganglion sentinelle dans les cancers de la cavité orale : impact clinique et apport de l’imagerie hybride

ObjectivesWe report a prospective evaluation of the sentinel lymph node identification and biopsy in oral cavity cancer in order to assess the additional value of the single photon emission computed tomography-computed tomography (SPECT-CT).Patients and methodsThirteen patients with T1 or T2 clinical N0 oral cavity cancer were prospectively included. They first underwent a lymphoscintigraphy with planar imaging. A SPECT-CT was performed secondly. Finally, excised sentinel lymph nodes were screened according to a specific histological processing.ResultsThe scintigraphic detection rate was 100%, both with planar and SPECT/CT imaging. Dynamic and early images were predictive of the lymph node drainage territory for 11 patients (85%). An impact of SPECT/CT in 83% of cases was achieved with additional quantitative information in 58% cases and qualitative information in 58% cases. A greater sensibility was also pointed out for level 1 sentinel lymph nodes, close to the injection site. Once, an occult metastasis was revealed by the histological analysis of the sentinel lymph nodes.ConclusionRadioisotopic sentinel lymph node technique for oral cavity cancers allowed determining neck node status for all patients. Ninety-two percent of them were spared from a radical neck dissection or radiotherapy. Preoperative detection of sentinel lymph node is optimised in most cases by hybrid imaging procedure. Anatomical data provided by hybrid imaging are useful for surgery.     

Diagnostic value of EBUS-TBNA for lung cancer with non-enlarged lymph nodes: a study in a tuberculosis-endemic country

Background

In tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) enables real-time nodal sampling, and thereby improves nodal diagnosis accuracy. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET.

Methods

We studied 43 lung cancer patients with CT-defined non-enlarged mediastinal and hilar lymph nodes and examined 78 lymph nodes using EBUS-TBNA.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 80.6%, 100%, 100%, and 85.7%, respectively. PET had low specificity (18.9%) and a low positive predictive value (44.4%). The diagnostic accuracy of EBUS-TBNA was higher than that of PET (91% vs. 47.4%; p<0.001). Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes. Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB. Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.

Conclusion

In a TB-endemic area with a condition of CT-defined non-enlarged lymph node, the negative diagnostic impact of PET limits its clinical usefulness for nodal staging; therefore, EBUS-TBNA, which facilitates direct diagnosis, is preferred.     

The Value of T2* in Differentiating Metastatic from Benign Axillary Lymph Nodes in Patients with Breast Cancer - A Preliminary In Vivo Study

Background

Accurate detection and determination of axillary lymph node metastasis are crucial for the clinical management of patients with breast cancer. Noninvasive imaging methods including ultrasound (US), computed tomography (CT), or conventional magnetic resonance imaging (MRI) are not yet accurate enough. The purpose of this study was to investigate the value of in vivo T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer.

Methodology/Principal Findings

In this institutional review board approved study, 35 women with breast cancer underwent multi-echo T2* weighted imaging (T2*WI) of the axillary area on a 3.0 T clinical magnetic resonance (MR) imaging system. T2* values of pathologically proven benign and metastatic axillary lymph nodes were calculated and compared. Receiver operating characteristics (ROC) analysis was conducted to evaluate the diagnostic ability. The areas under the ROC curve (AUCs) and the confidence intervals (CIs) were assessed. In total, 56 metastatic and 65 benign axillary lymph nodes were identified in this study. For metastatic lymph nodes, the average T2* value (55.96±11.87 ms) was significantly longer than that of the benign lymph nodes (26.00±5.51 ms, P<0.05). The AUC of T2* in differentiating benign from metastatic lymph nodes was 0.993. The cut-off value of 37.5 milliseconds (ms) gave a sensitivity of 94.6%, a specificity of 98.5%, a positive predictive value of 98.17 and a negative predictive value 95.54.

Conclusions

In vivo T2* can differentiate benign from metastatic axillary lymph nodes in patients with breast cancer. The high sensitivity and specificity as well as the easiness suggest its high potential for use in clinical practice.     

x线断层容积成像技术在肺动脉畸形中的应用

目的：通过与常规x线胸片比较,探讨胸部x线断层容积成像技术在肺动脉畸形中的应用价值。方法：对20例临床及x线平片怀疑肺动脉畸形者,进一步进行胸部x线断层容积成像检查。其中11例被明确诊断为肺动脉畸形。以CT或超声心动结果为标准,对比两种图像对肺动脉畸形的明确诊断率,分析对比该11例患者的胸部x线断层容积成像图片和普通x线胸片,评价两种方法所获得的图像质量和图片优秀率。结果：20例疑似患者中,11例被CT或超声心动确诊为肺动脉畸形,其x线断层容积成像图片和普通x线胸片经主管技师和副主任医师双盲判读,x线断层容积成像11例均获明确诊断（100％）,普通x线胸片明确诊断2例（18％）,诊断准确率有明显差异（P=0．O001）。容积断层成像优质图像为10例,占总数的90．91％;良好1例,差为0例。11例x片中优秀7例,占总数的63．63％,其中良好3例,差1例。两种图像优秀率比较差异有统计学意义（P=0．0001）。结论：x线断层容积成像技术对肺动脉畸形的图像优秀率和诊断准确率均高于x线平片,对病变的显示更加清晰、立体,提高诊断准确率和客观性,具有重要的临床诊断价值。     

Confirmation of histology of PET positive lymph nodes recovered by hand-video-assisted thoracoscopy surgery

PET/CT (Positron Emission Tomography-Computed Tomography) is an advanced diagnostic imaging device that combines both PET and an X-ray CT. This study evaluates the effects of PET/CT on detecting primary tumors and metastases, and looks at the therapeutic effect of minimally invasive surgery on esophageal cancer patients. Eighty patients with esophageal cancer were enrolled in the study between January, 2004 and December, 2007, who were randomly divided into two groups of 40, one of which was treated with hand-video-assisted thoracoscopy surgery (HVATS) esophagectomy and one of which was treated with conventional surgery. All patients underwent a PET/CT scan 2-3weeks before their operation, and their cervical, thoracic and upper abdominal lymph nodes were biopsied. All the primary esophageal lesions showed high FDG uptake. The maximum standardized uptake value (SUV) was 3.78-25.64 (11.73±5.32), while the mean SUV was 3.65=16.92 (9.12±4.37). Using 2.5 as the SUV standard, all esophageal lesions were detected by PET/CT image. Of the 80 patients, 53 had lymph nodal metastases, with a total of 142 metastatic lymph nodes, which showed high FDG uptake. The maximum SUV was 2.77-14.63 (7.98±3.25), and the mean SUV was 2.31-12.84 (5.34±3.19). The visual analysis from the PET/CT scan showed a sensitivity of 86.62%, a specificity of 95.85%, a positive predictive value of 93.89%, a negative predictive value of 90.69% and an accuracy of 91.94%. The PET/CT scan showed a high sensitivity and specificity in detecting primary esophageal cancer and lymph nodal metastases. The mean post-surgery life expectancies for patients undergoing HVATS and conventional surgery are 27.93months and 28.05months, respectively. The two groups showed no statistically significant difference. We thus conclude that PET/CT combined with HVATS is a new choice for esophageal carcinoma patients.     

Bi-Directional X-Ray Phase-Contrast Mammography

Phase-contrast x-ray imaging is a promising improvement of conventional absorption-based mammography for early tumor detection. This potential has been demonstrated recently, utilizing structured gratings to obtain differential phase and dark-field scattering images. However, the inherently anisotropic imaging sensitivity of the proposed mono-directional approach yields only insufficient diagnostic information, and has low diagnostic sensitivity to highly oriented structures. To overcome these limitations, we present a two-directional x-ray phase-contrast mammography approach and demonstrate its advantages by applying it to a freshly dissected, cancerous mastectomy breast specimen. We illustrate that the two-directional scanning procedure overcomes the insufficient diagnostic value of a single scan, and reliably detects tumor structures, independently from their orientation within the breast. Our results indicate the indispensable diagnostic necessity and benefit of a multi-directional approach for x-ray phase-contrast mammography.     

Flow cytometric DNA analysis combined with fine needle aspiration biopsy in the diagnosis of palpable metastases

To determine the diagnostic value of flow cytometric (FCM) DNA analysis in combination with fine needle aspiration (FNA) biopsy, the nuclear DNA content was analyzed in FNA specimens from 155 superficial metastases and 60 benign lymph nodes. The results of FCM DNA analysis were considered to be positive for malignancy if DNA aneuploidy was found or if more than 12% S+G2M cells were present in the aspirate in diploid cases. The diagnostic accuracy of FCM DNA analysis alone in detecting malignancy was 92%, with a sensitivity of 91% and a specificity of 95%. FCM suggested the correct diagnosis in 5 of the 7 cytologically false-negative cases and in 9 of the 12 cytologically indeterminate or suspicious cases.     

64排多层螺旋CT对直肠癌淋巴结转移的诊断研究

目的:通过对直肠癌患者原发肿瘤周围脂肪间隙内淋巴结的影像学分析,来评价64排增强螺旋CT对直肠癌淋巴结转移的诊断价值。方法:收集我院经术后病理证实的102例直肠癌患者的临床及影像学资料进行回顾性分析,通过多平面成像,记录直肠周围脂肪间隙内淋巴结的CT表现,包括淋巴结大小、边缘及强化程度。以病理结果为准确定转移性和非转移性淋巴结,采用双盲法。结果:单因素分析结果显示淋巴结大小、边缘及强化方式与阳性率有显著的相关性(P0.05),多因素分析结果显示各相关因素有显著诊断意义的是淋巴结大小、边缘及强化方式,其敏感性分别为94.7%、87.6%、56.9%,特异性分别为69.3%、51.6%、62.3%。结论:综合分析原发肿瘤周围脂肪间隙内淋巴结的表观情况,有助于提高对淋巴结转移的判断。     

Susceptibility Weighted Imaging: A New Tool in the Diagnosis of Prostate Cancer and Detection of Prostatic Calcification

Background

Susceptibility weighted imaging (SWI) is a new MRI technique which has been proved very useful in the diagnosis of brain diseases, but few study was performed on its value in prostatic diseases. The aim of the present study was to investigate the value of SWI in distinguishing prostate cancer from benign prostatic hyperplasia and detecting prostatic calcification.

Methodology/Principal Findings

23 patients with prostate cancer and 53 patients with benign prostatic hyperplasia proved by prostate biopsy were scanned on a 3.0T MR and a 16-row CT scanner. High-resolution SWI, conventional MRI and CT were performed on all patients. The MRI and CT findings, especially SWI, were analyzed and compared. The analyses revealed that 19 out of 23 patients with prostate cancer presented hemorrhage within tumor area on SWI. However, in 53 patients with benign prostatic hyperplasia, hemorrhage was detected only in 1 patient in prostate by SWI. When comparing SWI, conventional MRI and CT in detecting prostate cancer hemorrhage, out of the 19 patients with prostate cancer who had prostatic hemorrhage detected by SWI, the prostatic hemorrhage was detected in only 7 patients by using conventional MRI, and none was detected by CT. In addition, CT demonstrated calcifications in 22 patients which were all detected by SWI whereas only 3 were detected by conventional MRI. Compared to CT, SWI showed 100% in the diagnostic sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) in detecting calcifications in prostate but conventional MRI demonstrated 13.6% in sensitivity, 100% in specificity, 75% in accuracy, 100% in PPV and 74% in NPV.

Conclusions

More apparent prostate hemorrhages were detected on SWI than on conventional MRI or CT. SWI may provide valuable information for the differential diagnosis between prostate cancer and prostatic hyperplasia. Filtered phase images can identify prostatic calcifications as well as CT.     

The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes. The material was analysed in 218 cases with enlarged supraclavicular lymph nodes in which FNAC was performed by the conventional method. In all cases cytological examination was performed on-site after staining the smears by the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The FNAC diagnosis was supported by examining cell blocks which added the reliability of histological architecture; further support was obtained by tissue biopsy and/or comparison with the primary tumour in some of the cases. Eleven cases were diagnosed as inflammatory lesions and 41 cases were unsatisfactory because of scanty/acellular samples (despite two to three repeat samplings). However, in five of these, malignant tumours were later found on biopsy, which was done for persistent enlargement of the supraclavicular lymph node(s). Fifty-three cases were diagnosed as negative for malignancy (normal cellular elements, n=15; reactive elements, n=38) and 12 cases were suspicious of malignancy. In 11 cases a diagnosis of lymphoma was made on histology and in 90 cases metastatic tumours were diagnosed. The overall sensitivity was 92.7%, specificity 98.5%, positive predictive value 97.3% and the negative predictive value was 94.8%. Based on our study we feel that FNAC of palpable supraclavicular lymph nodes as a first line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on appropriate management. Furthermore, the histological architecture from cell blocks can be correlated with cytology, and such material can be used for appropriate histochemical and immunomarker studies, which can be useful in enhancing the diagnosis.     

高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值

目的:研究高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结的鉴别价值。方法:选择2015年2月~2016年6月在我院进行诊治的乳腺癌患者150例,应用高频二维超声结合彩色多普勒血流显像技术,观察腋窝肿大淋巴结的声像图及血流情况。结果:经二维超声发现,乳腺癌腋窝良性淋巴结的皮质多向心增厚(68.93%)、长短径比L/S多2.0(70.58%)、多不融合(93.14%)、多无钙化斑(97.06%);腋窝转移性淋巴结的皮质多偏心增厚(68.48%)、长短径比L/S多2.0(69.57%)、多融合(68.48%)、多有钙化斑(77.17%);两者相比有明显差异(P0.05);经彩色多普勒血流显像技术发现,乳腺癌腋窝良性淋巴结的血流信号分布多呈门型(63.17%),血流丰富程度多为Ⅱ级(54.35%);腋窝转移性淋巴结的血流信号分布多呈周边型(68.93%),血流丰富程度多为Ⅲ级(72.83%);两者相比有明显差异(P0.05)。结论:乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结在内部回声、形态、血流分布特点等方面有显著的差异,高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结具有较高的鉴别价值。     

Ki67与MRI在宫颈癌根治性手术后宫颈癌淋巴结转移中评价对比

摘要 目的：探究Ki67与MR在宫颈癌根治术后宫颈癌淋巴结转移中评估价值的对比。方法：选择2016年1月至2018年1月于我院接受宫颈癌根治术的151例宫颈癌患者,分别对其实施Ki67检测及MRI检测,以病理学检测结果为金标准,计算两种检测方式对宫颈癌淋巴结转移评估的准确度、敏感度、特异度、阳性预测值及阴性预测值,并进行对比分析。结果：检测评估发现,MRI对宫颈癌淋巴结转移评估准确度为31.79 %,灵敏度为46.75 %,特异度为16.22 %,阳性预测值为36.73 %,阴性预测值为22.64 %。Ki67检测对宫颈癌淋巴结转移评估准确度为42.38 %,灵敏度为52.56 %,特异度为31.51 %,阳性预测值为45.05 %,阴性预测值为38.33 %。两种检测方式对比显示Ki67对宫颈癌淋巴结转移具有更高的诊断准确度。结论：3 相比于MRI检测,Ki67对宫颈癌淋巴结转移具有更高的诊断准确度、特异度和阴性预测值,分析其原因与MRI检测受个体因素影响更大有关。     

MRI与CT检查对卵巢癌病理分期及复发转移的诊断价值对比研究

摘要 目的：对比磁共振成像（MRI）与计算机断层扫描（CT）检查对卵巢癌病理分期及复发转移的诊断价值。方法：纳入2017年1月～2019年1月于我院接受诊治的卵巢癌患者100例进行研究。所有患者术前均进行MRI与CT检查,并以术后病理组织活检结果为金标准,对比MRI与CT诊断卵巢癌与卵巢癌病理分期的准确率。所有患者均于首次检查6个月后进行复诊,对比MRI与CT诊断卵巢癌复发转移的准确率。结果：MRI诊断卵巢癌的确诊率为94.00%（94/100）,高于CT诊断的81.00%（81/100）;漏诊率为2.00%（2/100）,低于CT诊断的10.00%（10/100）（均P＜0.05）。MRI诊断卵巢癌Ⅰ期、Ⅱ期、Ⅲ期的准确率分别为93.33%（14/15）、95.00%（19/20）、93.33%（28/30）,高于CT诊断的60.00%（9/15）、65.00%（13/20）、73.33%（22/30）（均P＜0.05）。MRI诊断肠管及周围、盆腔淋巴结、腹膜后淋巴结、肝脏等远处侵袭和转移中的准确率分别为100.00%（26/26）、88.89%（24/27）、75.00%（18/24）、95.00%（19/20）,高于CT诊断的76.92%（20/26）、48.15%（13/27）、41.67%（10/24）、45.00%（9/20）（均P＜0.05）。结论：相较于CT检查,MRI检查诊断卵巢癌的准确率更高,漏诊率更低,且在卵巢癌病理分期以及复发转移的诊断准确率更高,具有较好的临床应用价值。     

Lymphoprostatic scintigraphy in regional lymphatic mapping in patients with prostate cancer

The purpose of the investigation was to upgrade the diagnosis quality for metastatic lesion to the regional lymp nodes in prostate cancer. The results of the most widely used diagnostic techniques (computed tomography (CT), magnetic resonance Imaging, (MRI), radionuclide studies (RNS), and ultrasonography (USG)), which had been compared with those of histology of removed lymph nodes, were assessed. For this, 74 patients with prostate cancer were comprehensively examined and treated at the Central Research X-ray Radiolological Institute. The comparative assessment of radiodiagnostic techniques (USG, CT, MRI, and RNS) showed the high informative value of retroperitoneal lymph nodal MRI in the detection of structural-and-morphological and anatomic-and-topographic changes in the lymph nodes (87.5% sensitivity, 83.3% specificity, and 85.7% accuracy). The developed lymphoprostatic scintigraphy (LPSG) is an informative technique that allows the better diagnosis of prostate metastases to the regional lymph nodes (92.4% sensitivity, 91.7% specificity, and 92.1% accuracy; the prognostic value of a positive result is 90.7%). LPSG is superior in its informative value to small pelvic USG and CT and inferior to indirect lymphoscintigraphy and yields valuable additional information on the physiological function of the small pelvic lymphatic collector.     

原发性胃淋巴瘤临床与内镜特征分析

目的:探讨影像学检查及胃镜、超声内镜对原发性胃淋巴瘤的术前诊断方法,以提高该疾病的术前诊断率。方法:总结我院经手术及病理证实的21例原发性胃淋巴瘤资料,评估胃镜活检、超声内镜及CT对该病诊断的作用。结果:21例术前CT检查,误诊为浸润型胃癌11例,间质瘤2例,未见明显异常3例。CT术前诊断率为23.8%(5/21)。全部患者均实施胃镜检查,活检病理诊断淋巴瘤14例,胃镜活检诊断率为66.7%(14/21)。其中10名患者实施超声胃镜检查,判断胃淋巴瘤6例、胃癌3例、间质瘤1例;术前诊断率为60.0%(6/10)。结论:胃镜及超声内镜是原发性胃淋巴瘤的主要术前诊断方式;CT扫描能明确有无纵隔及腹腔内淋巴结肿大,为原发性胃淋巴瘤提供诊断依据。     

Diagnostic Performance of Magnetic Resonance Cholangiopancreatography in Malignant Obstructive Jaundice

Malignant obstructive jaundice is caused by tumors arising from the head of the pancreas and biliary tree, or seen due to secondary metastases in the porta hepatis lymph nodes. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive diagnostic technique that can be used for imaging the entire biliary tree and pancreatic duct system. The objective of this study was to evaluate the accuracy of MRCP in the diagnosis of malignant obstructive jaundice. The methods used involved comparative review of the images obtained by using magnetic resonance imaging and MRCP as well as comparison between MRCP- and pathology-based diagnoses. The accuracy of MRCP-based diagnosis of malignant obstructive jaundice was analyzed. Our data show that the positive rate of anatomical diagnosis and the detection rate of bile ducts on the proximal side of obstruction are 100%. The diagnostic accuracy of malignant obstruction was 82.9%. MRCP was found to have high diagnostic specificity for determining the location and extent of obstruction. We, therefore, concluded that MRCP had significance for clinical diagnosis of malignant obstructive jaundice. The positive rate of localization diagnosis was 100%. Distinguishing the quality of obstruction was also important. The diagnostic accuracy of MRCP for malignant obstructive jaundice was remarkably higher.     

Prediction of Nodal Involvement in Primary Rectal Carcinoma without Invasion to Pelvic Structures: Accuracy of Preoperative CT,MR, and DWIBS Assessments Relative to Histopathologic Findings

Objective

To investigate the accuracy of preoperative computed tomography (CT), magnetic resonance (MR) imaging and diffusion-weighted imaging with background body signal suppression (DWIBS) in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.

Methods and Materials

Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS) were compared with the final histological findings.

Results

The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01) but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05). The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.

Conclusion

MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.     

Application of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Management of Mediastinal and Hilar Lymphadenopathy Without Intrapulmonary Mass: Experience from the Largest Cancer Center of Southern China

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for lung cancer diagnosis and lymph node staging. The purpose of this study was to investigate EBUS-TBNA for managing mediastinal and hilar lymphadenopathies without intrapulmonary masses. We retrospectively reviewed our EBUS-TBNA database that was obtained between August 2010 and October 2012. Mediastinal and hilar lymphadenopathies of unknown origin and in the absence of known pulmonary malignancies were included. Final diagnoses were determined by EBUS-TBNA, surgery, and/or clinical follow-up for at least 6 months. Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using standard statistical methods. We identified 128 patients with mediastinal and hilar lymphadenopathies and without intrapulmonary masses. EBUS-TBNA was successfully performed to obtain samples from 161 lymph nodes and mediastinal masses. EBUS-TBNA was diagnostic for 119 of 128 patients (93.0 %) for all disease categories. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of EBUS-TBNA were 89.8, 100, 100, 81.6, and 93.0 %, respectively. The procedures were uneventful and there were no severe complications. EBUS-TBNA is a safe, minimally invasive approach for diagnosing mediastinal and hilar lymphadenopathies without intrapulmonary masses. It obviates the need for more invasive procedures for tissue sampling of the mediastinum and hilum.     

Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study

A. Schiettecatte, C. Bourgain, C. Breucq, N. Buls, V. De Wilde and J. de Mey
Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study Objective: To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)‐guided fine needle aspiration cytology (FNAC) and liquid‐based cytology (Surepath^®) to reduce sentinel node procedures. Methods: In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. Results: US‐guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US‐guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node‐negative. The correlation between malignant FNAC and histopathology was 100%. US‐guided liquid‐based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. Conclusions: We advocate that US‐guided fine needle aspiration (FNA) combined with liquid‐based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.